<extend name="Public:common" />
<block name="main">
<div class="gallery">
   <div class="col-md-offset-2">
   <h2><strong>联系方式</strong></h2>
    <hr style="width:80%" class="col-md-offset-0"/>
    <h5><strong>请您准确填写您的联系方式，以便我们能够准确为您邮寄兑换的礼品。</strong></h5><br/>
	
	<form method="post" action="{:U('info/add')}">
	   <div class="form-group">
        <label>姓名：</label>
        <input type="text" name="realname"  class="form-control" style="width:50%" placeholder="请输入姓名">
	   </div>
	   <div class="form-group">
        <label>邮编：</label>
        <input type="text" name="zipcode" class="form-control" style="width:50%" placeholder="请输入邮编">
	   </div>
	   <div class="form-group">
        <label>住址：</label>
        <input type="text" name="location" class="form-control" style="width:50%" placeholder="请输入住址">
	   </div>
	   <div class="form-group">
        <label>电话：</label>
        <input type="text" name="tel"  class="form-control" style="width:50%" placeholder="请输入电话">
	   </div>
	   <div class="form-group">
        <label>支付宝账号：</label>
        <input type="text" name="alipay"  class="form-control" style="width:50%" placeholder="请输入支付宝账号">
	   </div>
	   <!--<div class="form-group">
		<input type="hidden" name="user_id" value="">
		</div>-->
		<button type="submit" class="btn btn-default">提交</button>
	</form>
	
</div>
</block>